Spike location and probability of epilepsy

Probability:	Most often associated with:
High probability of epilepsy (>85%):
Anterior-mid temporal spikes^*	Mesial temporal lobe epilepsy
Midline spikes^¶	Tonic-clonic seizures
Hypsarhythmia	Infantile epileptic spasms syndrome (IESS)
Slow spike-wave	Lennox-Gastaut syndrome (LGS)
Generalized paroxysmal fast activity	Lennox-Gastaut syndrome (LGS)
Moderate probability of epilepsy (<75%):
Frontal spikes^Δ	Frontal lobe epilepsy
Generalized spike-wave (≥3 Hz)	Absence epilepsy (CAE, JAE: 3 Hz), juvenile myoclonic epilepsy (JME: >3 Hz), and other primary generalized epilepsies
Centro-temporal spikes^◊	Self-limited epilepsy with centrotemporal spikes (SeLECTS)
Occipital spikes^§	Self-limited epilepsy with autonomic seizures (SeLEAS) and childhood occipital visual epilepsy (COVE)
Photoparoxysmal response	Primary generalized epilepsy

CAE: childhood absence epilepsy; JAE: juvenile absence epilepsy.

* >90% probability of seizures/epilepsy (adults)^[1].

¶ 76-91% probability of seizures/epilepsy (children)^[2].

Δ ~75% probability of seizures/epilepsy (children)^[3].

◊ ~40% probability of seizures/epilepsy (children)^[3].

§ 50% probability of seizures/epilepsy (children)^[3].

References:

Pedley TA, Mendiratta A, Walczak TS. Seizures and Epilepsy. In: Current Practice of Clinical Electroencephalography, Ebersole JS, Pedley TA (Eds), Lippincott Williams & Wilkins, Philadelphia 2003 p.506.
Ehle A, Co S, Jones MG. Clinical correlates of midline spikes. An analysis of 21 patients. Arch Neurol 1981; 38:355.
Kellaway P. The incidence, significance and natural history of spike foci in children. In: Current clinical neurophysiology: update on EEG and evoked potentials, Henry C (Ed), Elsevier, Amsterdam 1981 p.151.

Table modified and expanded from: Pillai J, Sperling MR. Interictal EEG and the diagnosis of epilepsy. Epilepsia 2006; 47 Suppl 1:14.

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